Medicare Agency Hampered By Six Years Without A CEO

The nation's largest health insurer hasn't had a full-fledged chief executive for more than six years.

No, it's not UnitedHealth Group or WellPoint -- it's the Centers for Medicare and Medicaid Services, the massive federal agency that oversees those two entitlement programs and is in charge of carrying out the implementation of big parts of President Barack Obama's health care reform law.

Obama's current nominee, Marilyn Tavenner, has been running the Centers for Medicare and Medicaid Services in an acting capacity since the December 2011. That isn't likely to change any time soon, Politico points out. Controversies about health care reform and the dysfunctional Senate are to blame.

Former CMS administrators say the agency runs better with a leader who has the Senate's stamp of approval, rather than someone with an "acting" administrator title. A confirmed appointee has more power to push back on Congress, the White House or other parts of the Department of Health and Human Services, they say. Anyone in an "acting" role -- but hoping for confirmation -- might worry about making waves or be hesitant about providing fodder to opponents.

During most of the 1980s, 1990s and early 2000s, people cycled in and out of the post with relative ease. Acting administrators served for only a few months between administrations or confirmed administrators. Even during the controversial debate over President Bill Clinton's "Hillarycare" in 1993, CMS nominee Bruce Vladeck's confirmation floated under the radar. His hearing lasted 45 minutes, and his confirmation passed the Senate unanimously, he said.